social and emotional impact after neonatal intensive care
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Social and Emotional Impact Social and Emotional Impact
afterafter
Neonatal Intensive CareNeonatal Intensive Care
Penny Glass, Ph.D.Penny Glass, Ph.D.Developmental PsychologistDevelopmental Psychologist
Children’s National Medical CenterChildren’s National Medical Center
Objectives:Objectives:
Understand the early pattern of typical Understand the early pattern of typical social/emotional developmentsocial/emotional development
Identify factors which impact Identify factors which impact social/emotional development during and social/emotional development during and after the NICU after the NICU
Understand the role of the professional in Understand the role of the professional in supporting social/emotional developmentsupporting social/emotional development
NORMAL PATTERN OF NORMAL PATTERN OF SOCIALIZATIONSOCIALIZATION
Roots of Attachment – Roots of Attachment – Development of TrustDevelopment of Trust
Independence/AutonomyIndependence/Autonomy
Importance of PeersImportance of Peers
Attachment: Attachment: Environmental PredispositionEnvironmental Predisposition
Imprinting in humans??
Early Attachment – Early Attachment – what the infant bringswhat the infant brings
Inborn social predilictionInborn social prediliction
Innate releasers Innate releasers (Bowlby)(Bowlby) Root/suck/cling/cryRoot/suck/cling/cry Visual regardVisual regard
+ Physical dependency+ Physical dependency
+ Cute+ Cute
++ own temperament own temperament
Biologically predisposed Biologically predisposed for social vs nonsocialfor social vs nonsocial
human voicehuman voice
empathic distressempathic distress
interactional interactional synchronysynchrony
Social Predisposition and Social Predisposition and Sensory Motor IntegrationSensory Motor Integration
Interactional Interactional synchrony..synchrony..
to human voiceto human voice
Social Predisposition Social Predisposition mutual exchanges & magic mutual exchanges & magic
momentsmoments
Predisposition for social vs Predisposition for social vs nonsocialnonsocial
searches for facial features (eyes!)searches for facial features (eyes!)
face/voice discrimination face/voice discrimination (parent/non-parent)(parent/non-parent)
reciprocal vocal playreciprocal vocal play
Attachment, Trust, and Attachment, Trust, and Contingency – Contingency –
who the infant chooseswho the infant chooses Biological mother Biological mother
facilitates facilitates attachment… but is attachment… but is not essentialnot essential
MoreMore important: important: sensitivitysensitivity contingent contingent
responsivenessresponsiveness emotional emotional
involvementinvolvementPower of the smile
Mama? She can’t compete!Mama? She can’t compete!
Attachment takes time….Attachment takes time….
From initial eye contact…From initial eye contact…
to shared experiences to shared experiences and social reciprocity……and social reciprocity……
Physical dependence and Physical dependence and development of languagedevelopment of language
Temperamental styleTemperamental style
EasyEasy
DifficultDifficult
Slow to WarmSlow to Warm
Match/MismatchMatch/Mismatch
Chess & ThomasChess & Thomas
Temperament as Temperament as emotional reactivity & self emotional reactivity & self
regulationregulation Approach/withdrawal to new situationApproach/withdrawal to new situation
Sensitivity to stimulationSensitivity to stimulation
Intensity of responseIntensity of response
Predominant mood (+ or -)Predominant mood (+ or -)
Emotional reactivity & self regulationEmotional reactivity & self regulation
Activity level, regularity of biorhythmsActivity level, regularity of biorhythms
DistractibilityDistractibility
Persistence in pursuing a goalPersistence in pursuing a goal
Adaptability to changeAdaptability to change
Stepping toward Stepping toward Independence & AutonomyIndependence & Autonomy
Power of walkingPower of walking
Touching base parent as Touching base parent as base of emotional supportbase of emotional support
self-regulation self-regulation
mastery motivationmastery motivation
Empathy: Empathy: From crying to caringFrom crying to caring From parent to othersFrom parent to others
2-year old dilemma!
Attachment and Separation Attachment and Separation AnxietyAnxiety
response to response to separation/reunionseparation/reunion SecureSecure Insecure ambivalentInsecure ambivalent Insecure avoidantInsecure avoidant DisorganizedDisorganized
……and temperamentand temperament
Attachment and Peers Attachment and Peers Task of the 3 year oldTask of the 3 year old
Practice with “pair-dates” Practice with “pair-dates” expands to group playexpands to group play
Needs: Needs: desire desire (biology/temperament)(biology/temperament)skills (lang. dependentskills (lang. dependent
1. art of conversation1. art of conversation2. negotiate a social 2. negotiate a social
contract, taking turnscontract, taking turns3. compromise and 3. compromise and
playing pretendplaying pretend
Social and Emotional Impact Social and Emotional Impact during/after NICUduring/after NICU
Factors which ImpactFactors which Impact
Parent Parent Child Child
““High Risk” NewbornHigh Risk” Newborn
physical separationphysical separation
vulnerable vulnerable appearanceappearance
““6 sticks of butter”6 sticks of butter”
disruption of biological disruption of biological clockclock
change of itinerarychange of itinerary
Loss of Identity as ParentLoss of Identity as Parent
Nurse…Nurse…Therapist….TeacherTherapist….Teacher
Force feeding and later Force feeding and later food refusalsfood refusals
Not doing enough….or Not doing enough….or doing too muchdoing too much
Later social isolationLater social isolation
Parents often try to compensate Parents often try to compensate for NICU experiencefor NICU experience
Prolonged Physical DependencyProlonged Physical Dependency
parent fatigueparent fatigue
effects our social effects our social interactioninteraction
parent depressionparent depression
Interference with PlayInterference with Play
physical limitations and physical limitations and type of toystype of toys
play is a social thing play is a social thing (language!)(language!)
teaching vs play timeteaching vs play time
parents searching for the parents searching for the “magic toy”“magic toy”
Sensory DeficitsSensory Deficits
auditory, visual, auditory, visual, tactiletactile
reciprocal reciprocal interaction interaction
communicationcommunication
Multisensory toys:Multisensory toys:- - heighten arousal, heighten arousal, notnot attention to what is attention to what is importantimportant- delay object relations - delay object relations - increase irritability- increase irritability
““Risks” of Therapeutic Risks” of Therapeutic InterventionsInterventions
Physical intrusionPhysical intrusion personal body space: personal body space:
physical discomfortphysical discomfort parent’s protective roleparent’s protective role
Multiple therapists and too many adultsMultiple therapists and too many adults Loss of parenting roleLoss of parenting role Loss of peers?Loss of peers?
““Risks”of Therapeutic Intervention Risks”of Therapeutic Intervention
Impact of excess reinforcementImpact of excess reinforcement loss of internal motivation loss of internal motivation becomes overly dependent on adultbecomes overly dependent on adult distracting from task goaldistracting from task goal
Never teach a child to do something that Never teach a child to do something that you later must teach him (her) not to do.you later must teach him (her) not to do.
Problem of Limits in Problem of Limits in Child with Special NeedsChild with Special Needs
Over-acceptance of Over-acceptance of inappropriate behaviorinappropriate behavior
Inhibition and brain Inhibition and brain damagedamage
Who loves a terror and Who loves a terror and a tyrant?a tyrant? Not even the parentNot even the parent
Beyond the NICUBeyond the NICU Family IssuesFamily Issues
Financial burdenFinancial burden SiblingsSiblings Adult relationshipsAdult relationships Facing the futureFacing the future
Community SupportCommunity Support Early InterventionEarly Intervention Neighbors and friendsNeighbors and friends
Cultural Expectations Cultural Expectations
SummarySummary
The social/emotional pathway for a NICU graduate The social/emotional pathway for a NICU graduate may be different, but it can be just as strong.may be different, but it can be just as strong.
The parent’s primary role as protector, a source of The parent’s primary role as protector, a source of safety and comfort in times of distress, is altered in safety and comfort in times of distress, is altered in the NICU and beyond.the NICU and beyond.
As professionals, we need to be aware of the As professionals, we need to be aware of the potential impact of our therapeutic approaches on potential impact of our therapeutic approaches on social/emotional development of the child and social/emotional development of the child and familyfamily
Selected ReferencesSelected References
Fetal Development: A Fetal Development: A Psychobiological Perspective. Jean-Psychobiological Perspective. Jean-Pierre Lecanuet, William Fifer, Pierre Lecanuet, William Fifer, Normal Krasnegor, & William Normal Krasnegor, & William Smotherman, eds. Hillsdale, NJ: Smotherman, eds. Hillsdale, NJ: Lawrence Erlbaum, 1995. Lawrence Erlbaum, 1995.
Attachment and Loss, J. Bowlby. New Attachment and Loss, J. Bowlby. New York: Basic Books, 1969. York: Basic Books, 1969.
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